The potential counter effect of COVID-19 outbreak on an antimicrobial agents prescribing educational intervention.

INTRODUCTION: Educational interventions targeting health care professionals can contribute to improving knowledge and behaviors of antimicrobial agents prescribing. However, the unprecedented COVID-19 outbreak caused a disruption of the current practices and treatment guidelines. Therefore, it is highly likely that the pandemic had its disruptive effect on any educational interventions that were going on during the outbreak. This study aims to evaluate the effectiveness of an educational intervention in improving antimicrobial agents prescribing. METHODOLOGY: This was a randomized controlled study that included 69 resident physicians in a teaching hospital. The intervention group received an educational intervention focusing on antimicrobial agents prescribing and resistance. Before and after the intervention, outpatient antimicrobial agents prescribing rates for the two study arms were compared for the pre- and post-intervention periods. Additionally, all participants were asked to complete an online questionnaire that measured their knowledge, attitudes and behavioral intention towards antimicrobial agents resistance and prescription. The post-intervention period included the months of February, March, and June 2020. April and May were excluded from the study period since clinics were closed due to the COVID -19 pandemic. RESULTS: Post-intervention, the rate of antimicrobial agents prescribing by the intervention group was significantly higher than that of the control group (p < 0.001). Mean fear score for the intervention group was significantly lower than that for the control group after the intervention. CONCLUSIONS: Findings indicate failure of the educational intervention in improving antimicrobial agents prescribing. However, an unexpected counter effect of the COVID-19 outbreak is highly likely.

Risk management of teratogenic medicines: A systematic review.

AIM: To systematically identify studies of implementing risk management measures when prescribing teratogenic medicines for women of childbearing age and studies reporting risk perceptions of teratogenic medications. METHODS: MEDLINE, CINAHL, Scopus, EMBASE, and International Pharmaceutical Abstracts were searched. Studies were included in the risk management section if they reported any of the following risk management measures: teratogenic counseling, contraceptive counseling, pregnancy testing before starting treatment, pregnancy testing during treatment, use of contraception before starting treatment, and use of contraception during treatment. Studies were included in the perceptions section if they reported perceived teratogenic risk as numerical value. RESULTS: Fifty-five studies were included in the risk management section and seven studies were included in the perceptions sections. Prevalence of risk management measures varied as follows: teratogenic counseling (9.5%-99.3%), contraceptive counseling (6.1%-98%), pregnancy testing before starting treatment (0%-95.1%), pregnancy testing during treatment (12.7%-100%), contraception use before starting treatment (15.7%-94%), and contraception use during treatment (1.7%-100%). A proper estimation of the teratogenic risk was reported for thalidomide (by general practitioners and obstetric/gynecologists), for etretinate (by pregnant women), and for misoprostol (by pregnant and nonpregnant women). An under-estimation was reported for warfarin and retinoids (by general practitioners and obstetric/gynecologists). And over-estimation was reported for thalidomide, valproate, lithium, isotretinoin, phenytoin, warfarin and etretinate by different populations. CONCLUSION: Considerable variation in the implementation of risk management measures when prescribing teratogenic medicines to women of childbearing age is reported in the literature. A common tendency to over-estimate the risk of teratogenic medications was evident.

A survey on the knowledge, attitudes and practices of physicians towards pharmacovigilance in Jordanian health centres.

Background: Knowledge, attitudes and practices of health care professionals towards pharmacovigilance are strongly associated with reporting adverse drug reactions, as proven by a number of studies. This study aims to evaluate the levels of knowledge, attitudes and practices towards pharmacovigilance among physicians working at health centres of the Jordanian Ministry of Health. Methods: This took the form of a cross-sectional survey. Questionnaires were distributed by the researcher and research assistant to the physicians. Twenty primary and comprehensive health centres were covered. Results: The study included 106 physicians. Poor knowledge and practices were observed (mean knowledge score of 1.5±1.2 out of five, and mean practice score of 5.5±1.8 out of 15), while a high level of positive attitudes was observed (mean attitude score of 9.3±1.3 out of 10). Half of the physicians were aware that monitoring adverse drug reactions in Jordan is carried out by the Jordan Pharmacovigilance Centre. The majority of physicians (95.2%) mentioned that they rarely or never used the adverse drug reactions reporting form in Jordan. Conclusions: It is clear that there is a need to initiate educational activities and intervention programmes to raise the awareness of health care providers in Jordan regarding pharmacovigilance.

Trends in the Incidence of Cervical Cancer in Jordan, 2000-2013.

OBJECTIVES: To determine the incidence of cervical cancer in Jordan and assess its trend in over a 14-year period (2000-2013). METHODS: This descriptive study was based on secondary analysis of cervical cancer data that are registered in the Jordan Cancer Registry (JCR). RESULTS: A total of 591 women were diagnosed with cervical cancer in Jordan during the period 2000-2013. The age at diagnosis ranged between 15 and 97 years, with a median of 50 years. The average age standardized rate (ASR) was 2.0/100,000 women. The incidence of cervical cancer started to decrease after 2006 but it remained relatively constant between 2008 and 2013. Over the 14-year period, ASR for cervical cancer decreased by 28.6% from 2.1 per 100,000 women in 2000 to 1.5 per 100,000 women in 2013. About 46.5% of the cases were of squamous cell carcinoma morphology. Early cancer constituted about 60% of the cases, regional cases constituted 9.6%, and distant metastatic cases constituted 10.7%. CONCLUSIONS: The incidence of cervical cancer in Jordan is low compared to regional estimates and remained relatively constant between 2008 and 2013. Implementation of screening measures could lead to better case finding, early diagnosis, and prevention of cervical cancer.

Serum vitamin D and the metabolic syndrome among osteoporotic postmenopausal female patients of a family practice clinic in Jordan.

BACKGROUND: Vitamin D deficiency and insufficiency and the metabolic syndrome are two common health issues worldwide. The association between these two health problems is subject to debate. OBJECTIVES: This study aims to investigate the association between vitamin D deficiency or insufficiency and the metabolic syndrome in a sample of osteoporotic postmenopausal women attending a family practice clinic in Amman-Jordan. MATERIAL AND METHODS: This was an observational cross sectional study. It was carried out in the family practice clinic in Jordan University Hospital. The study included all postmenopausal osteoporotic women attending the clinic between June 2011 and May 2012, yielding a total of 326 subjects. The association between metabolic syndrome and serum vitamin D levels was investigated. RESULTS: Waist circumference, body mass index, triglycerides and fasting blood sugar were significantly higher among postmenopausal women with metabolic syndrome, but HDL cholesterol was significantly lower (p<0.05). The prevalence of metabolic syndrome among all study participants was 42.9%. Triglycerides and LDL cholesterol were significantly higher among women deficiency or insufficiency (p<0.05). The prevalence of vitamin D deficiency or insufficiency was 45.7%. Among patients with metabolic syndrome, the prevalence of vitamin D deficiency or insufficiency was 50.7%. CONCLUSIONS: Findings of the current study suggest a lack of relationship between serum vitamin D and metabolic syndrome. However, a significant inverse relationship was found between serum vitamin D levels and both serum triglycerides and LDL levels.